Shut-In? Impact of Chronic Conditions on Community Participation Restriction among Older Adults.

Abstract

Community participation may be especially important for older adults, who are often at risk for unwanted declines in participation. We estimated the prevalence of community participation restriction (PR) due to perceived environmental barriers among older adults (≥50 years) and compared the impact among those with selected chronic conditions. Individuals with low-prevalence conditions reported high community PR (9.1-20.4%), while those with highly prevalent conditions (e.g., arthritis) had relatively low community PR (5.1-10.0%) but represented the greatest absolute numbers of condition-associated burden (>1 million). Across all conditions, more than half of those with community PR reported being restricted "always or often." Community PR most often resulted from modifiable environmental barriers. Promising targets to reduce community PR among adults ≥50 years with chronic conditions, particularly arthritis, include building design, sidewalks/curbs, crowd control, and interventions that improve the built environment.

Participants were shown a list of ten environmental barriers (building design, lighting, sound, crowds, sidewalks and curbs, and transportation, household or workplace equipment hard to use, attitudes of other people, policies, and other) and were asked: “Thinking of COMMUNITY ACTIVITIES such as getting together with friends or neighbors, going to church, temple, or another place of worship, movies, or shopping, do problems with any of these things on the list NOW limit or prevent your participation in community activities?” (Figure 1). Community PR was defined as a “yes” to this question. Respondents answering yes were next asked to identify which items on the list were barriers to them and to report how often they experienced these barriers (collapsed to always/often or sometimes/rarely). Conceptually, the first three barriers (building design, lighting, and sound) fit together as “accessibility barriers,” while crowds, sidewalks/curbs, and transportation made up a category of “mobility barriers.” “Household/workplace equipment hard to use” was omitted because it pertained to noncommunity settings; “other” was excluded because of high item nonresponse. “Attitudes of other people” was analyzed independently. The policy category was excluded from the analysis because it had a low item response rate with estimates failing to meet minimum reliability criteria (relative standard error <30.0) for any condition examined.